Successful removal of pacemakers in patients with Lyme carditis

Man with Lyme carditis and a pacemaker implantation talks to doctor.

Some patients with Lyme carditis may require a pacemaker for conduction abnormalities. In a recent study, investigators described the successful removal of pacemakers in two patients with Lyme carditis who recovered normal atrioventricular node conduction.

 

In their study “Pacemaker Explantation in Patients With Lyme Carditis,” Wamboldt and colleagues¹ describe two cases involving the removal of pacemakers in patients with Lyme carditis, which highlights the importance of including Lyme carditis in the differential diagnosis for high-degree AV block.

Furthermore, these cases demonstrate the “benefits of early device interrogation in patients who have been treated for Lyme carditis and received a pacemaker during their treatment,” the authors explain.

Lyme carditis can lead to cardiac arrhythmias and conduction disorders, most commonly atrioventricular (AV) blocks.

Case #1

“A 48-year-old woman presented with shortness of breath and dizziness secondary to complete heart block,” the authors write. “Given the presence of symptomatic bradycardia, she was transferred to a tertiary hospital for pacemaker implantation.”

She had a non-specific rash on her abdomen 3 months before symptom onset.

Lyme disease testing was positive.

Authors’ Takeaway: “Pacemaker explantation is a potential option for patients with treated [Lyme carditis] who have undergone proper testing to ensure that normal cardiac conduction has resumed.”

Case #2

A 58-year-old man presented with dizziness, syncope, headache and myalgia. “His initial electrocardiogram showed atrial fibrillation with slow ventricular response,” the authors write. “During his admission he experienced symptomatic pauses lasting 4 to 10 seconds.”

He also had a pacemaker implantation.

Lyme disease testing was positive.

Both patients were treated successfully with antibiotics.

Typically, Lyme disease patients with conduction problems are placed on a temporary pacemaker. In both of these cases, the patients were placed on a permanent pacemaker.

On follow-up, both pacemakers were functioning. “Both patients underwent exercise stress testing and were able to maintain 1:1 conduction at a heart rate >120 beats/min,” according to the authors.

The permanent pacemakers were removed successfully.

“Within the first year of insertion, transvenous lead extraction has a high success rate and a low complication rate,” the authors explain. The pacemaker is more difficult to remove if present over a year due to fibrotic changes.

“This highlights the importance of close follow-up so that early pacemaker explantation can be arranged if clinically indicated,” the authors suggest.

References:
  1. Wamboldt R, Wang CN, Miller JC, Enriquez A, Yeung C, Chacko S, Foisy M, Baranchuk A. Pacemaker Explantation in Patients With Lyme Carditis. JACC Case Rep. 2022 May 18;4(10):613-616. doi: 10.1016/j.jaccas.2022.02.012. PMID: 35615211; PMCID: PMC9125511.


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